Solve study: a study to capture global variations in practices concerning laparoscopic cholecystectomy.

Area of Science:

• Surgical Practice
• Minimally Invasive Surgery
• Gastrointestinal Surgery

Background:

• Limited published data exists on practice variations for laparoscopic cholecystectomy.
• Understanding these variations is crucial for improving patient care and surgical outcomes.

Purpose of the Study:

• To document global variations in preoperative, perioperative, and postoperative practices related to laparoscopic cholecystectomy.
• To identify areas of consensus and divergence in surgical approaches.

Main Methods:

• A 45-item electronic survey was developed to assess practice variations.
• The survey was distributed globally through professional surgical organizations and social media.
• Data was collected from 638 surgeons across 70 countries.

Main Results:

• Significant variations were observed in preoperative diagnostics, management of common bile duct stones (85.4% ERCP vs. 10.8% CBD exploration), and timing of cholecystectomy for gallstone pancreatitis (61.2%).
• Antibiotic prophylaxis (57%) and DVT prophylaxis (70% do not use pharmacological) practices varied.
• Techniques for pneumoperitoneum (open juxta umbilical preferred, but varied with obesity/prior laparotomy), port insertion (blunt ports preferred by 57.7%), and vessel/duct control (Liga clips and Hem-o-loks® commonly used) showed diversity.
• Nearly all surgeons (97.4%) deemed removing stones from Hartmann's pouch important if total cholecystectomy was not feasible.

Conclusions:

• This study underscores substantial global variations in laparoscopic cholecystectomy practices.
• The findings highlight the need for further research and potential development of standardized protocols to optimize patient management.